PB2246: FEATURES OF THE SECRETION OF HEPCIDIN, A SOLUBLE TRANSFERRIN RECEPTOR DEPENDING ON THE TYPE OF ANEMIA IN PATIENTS WITH MALIGNANT NEOPLASMS
Authors: V. Sakhin, E. Kryukov, S. Kazakov, A. Sotnikov, A. Gordienko, N. Gulyaev, O. Rukavitsyn
Journal: HemaSphere (2022)

Background: Anaemia of chronic disease or anaemia of chronic inflammation is the most common cause of anaemia in admitted patients. This anemia can be a consequence of several states such as malignancies, chronic infections and auto-immune diseases, thereby indicating the multiplicity in pathogenetic pathways. Aims: to study the secretion of hepcidin a soluble transferrin receptor (sTfR) in patients with malignant neoplasms with anemia of chronic diseases (ACD), iron deficiency anemia (IDA) and an ACD/IDA combination and to investigate their effect on the development of anemia Methods: 106 patients with stage II-IV of solid malignant neoplasms were examined: 84 with anemia (55 men, 29 women, 67.1±9.9 year olds), 22 without anemia (17 men, 5 women, 60.2±14.9 year olds). According to Van Santen and Worwood criteria, by determining the transferrin saturation index (TSI), ferritin, C-reactive protein (CRP), patients were divided into 4 groups: group 1 - ACD, 31 (20/11 patients (hemoglobin 99.2[IQR,87-118], erythrocytes 3.5[IQR,3.1-3.9], TSI 19.9[IQR,12.6-22], ferritin 443.4[IQR,361.9-574.9], CRP 137.1[IQR,89.7-155.2]), group 2 – ACD/IDA, 28 (18/10) patients (hemoglobin 111[IQR,91-128], erythrocytes 4.02[IQR,3.3-4.5], TSI 12.7[IQR,7.4-20.5], ferritin 220.5[IQR,102.7-370.6], CRP 53.4[IQR,14.5-64.5]), group 3 - IDA, 25(17/8) patients (hemoglobin 107 [IQR,96.5-121.5], erythrocytes 4.1[IQR,3.7-4.5], TSI 7.3[IQR,4.2-12.5], ferritin 19.3[IQR,10-24.1], CRP 14[IQR,6.6-23.9]), group 4(control) - 22 patients without anemia (hemoglobin 135.3[IQR,125-150], erythrocytes 4.4[IQR,3.9-4.9], TSI 16.8[IQR,12.4-21.6], ferritin 111[IQR,25.7-189.2], CRP 11.4[IQR,3.3-16.8]). The significance of differences between several unrelated groups was determined using the Kruskal-Wallis test at a significance level (p) of less than 0.05. To assess the relationship between the variables, the Spearman correlation coefficient (r) was calculated. Results: the ACD group had the highest concentrations of CRP, ferritin in comparison with the other groups (p<0.05). The TSI in the ACD group was higher compared to the IDA and ACD/IDA groups (p<0.05), and did not differ from the control group (p>0.05). The ACD group had the maximum concentration of hepcidin (47.3[IQR,29.7-60.5]) compared with the ACD/IDA group (34.6[IQR, 26.6-50]) (p<0.05), the IDA group (6.16[IQR,1.8-10]) (p<0.05) and the control group (23.5[IQR,4.7-45.4) (p<0.05). The concentration of sTfR in patients with anemia did not differ (p>0.05) and amounted to 26.1[IQR,19.8-28.3] in ACD, 23[IQR,13.3-21.1] in ACD/IDA, 28.4[IQR,16.1-34.4] in IDA, 16.8[IQR,13.7-18.8] in the control group. In all groups with anemia, the concentration of sTfR was higher compared to the control group (p<0.05). A correlation was found between the number of erythrocytes and the concentration of hepcidin (r=-0.57), as well as between the concentration of hemoglobin and sTfR (r=-0.57). Summary/Conclusion: Patients with solid malignancies may have IDA, ACD, or a combination of both. The high concentration of hepcidin in patients with ACD, the presence of a correlation between it and erythrocytes confirms its importance in the development of anemia and the possibility of using it for the diagnosis of ACD. The absence of differences in the concentration of sTfR between patients of the three groups with anemia indicates a low value of this indicator for the differential diagnosis of ACD and IDA. The correlation between sTfR and hemoglobin reflects the importance of sTfR in the pathogenesis of anemia in cancer patients.